Organization
CORE REVIVE PHYSICAL THERAPY AND WELLNESS (IS THE DBA, JACKIE KICKISH LLC)
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACKIE MARIE KICKISH PT, DPT (PHYSICAL THERAPIST)
(513) 917-9418
Entity
Organization
Contact information
Practice address
6577 HERRON CT, MASON, OH 45040-9392
(513) 917-9418
Mailing address
6577 HERRON CT APT SUITE, MASON, OH 45040-9392
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
11/10/2025
Last updated
11/10/2025
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